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Biomedical subjects

I D Civil

Publications and source records attributed to I D Civil.

At least 19 recordsLinked to original sources
PubMed2001

Trauma training in Australia and New Zealand: results of a survey of advanced surgical trainees.

BACKGROUND: The surgical management of trauma within Australia and New Zealand has recently been undergoing major organizational changes. The aim of the present paper was to evaluate the attitudes and experience of Australian and New Zealand advanced surgical trainees in this changing climate and to identify problems with trauma training. METHODS: A survey assessing important areas of trauma management and training was sent to all advanced surgical trainees of the Royal Australasian College of Surgeons. RESULTS: Two hundred and seventy-two of 587 trainees responded (46%). Overall 85% of trainees believed they would be involved in trauma management in the future. The majority of trainees reported low rates of involvement and consultant supervision in trauma resuscitations. Only 32% of general surgical trainees believed that their exposure to major trauma operations was very adequate despite an average of 12.3 trauma operations per year. Seventy per cent of general surgical trainees reported a very adequate level of consultant supervision at trauma operations. In contrast 86% of orthopaedic trainees reported a very adequate exposure to trauma operations with an average of 221 orthopaedic trauma operations per year. Only 46% of orthopaedic trainees reported a very adequate level of consultant supervision at trauma operations. CONCLUSIONS: Regional rotations may need to be developed to even out trainees' experience in trauma management. The low level of supervision in trauma resuscitations and orthopaedic surgical training requires attention. This survey warrants repeating in a prospective manner.

Attitude of Health Personnel↗
PubMed2000

Surgery in New Zealand.

Surgery in New Zealand is performed by more than 500 surgeons who serve a population of 3.8 million people. Most of the surgeons are trained in New Zealand under the auspices of the Royal Australasian College of Surgeons. Surgical services are consistent with the highest standards of Western countries.

Cross-Cultural Comparison↗
PubMed2000

Lumbar transverse process fractures--a sentinel marker of abdominal organ injuries.

Fractures of lumbar vertebrae may be associated with abdominal organ injuries. Lumbar transverse process fractures are commonly thought of as minor injuries compared with body, pedicle and lamina fractures. To determine the significance of transverse process fractures as opposed to other lumbar vertebral fractures in relation to abdominal organ injury, a retrospective study was performed. One hundred and ninety-one patients with lumbar spine fractures were reviewed. One hundred and thirty-five (71%) of these had non-transverse process (NTP) fractures only (including vertebral body, pedicle, or spinous process fractures). Fourty-two patients (22%) had transverse process fractures only. Fourteen patients (7%) had both transverse process and NTP fractures. Twenty (48%) of the 42 patients with transverse process fractures had abdominal organ injuries identified. This was a significantly (P<0.05) higher rate than for the patients with NTP fractures, eight of 135 (6%). Patients with transverse process fractures and abdominal organ injuries had a median injury severity score (ISS) of 29 compared with a median ISS of 17 for patients with NTP fractures and abdominal organ injuries. If a transverse process has been fractured, there is likely to have been very large forces involved in the incident. The data strongly suggest that lumbar transverse process fractures should not be thought of as minor injuries but regarded as a significant marker for abdominal organ injuries and should alert the doctor caring for the injured patient of the high probability of these injuries.

Abdominal Injuries↗
PubMed1999

Serum levels of insulin-like growth factor binding protein-3 in benign and malignant breast disease.

BACKGROUND: The insulin-like growth factors IGF-I and IGF-II and their major binding protein IGFBP-3 influence the growth of breast cancer cells in vitro. Some benign non-breast tumours appear to be associated with increased serum IGFBP-3 levels which would tend to reduce bioactive-free IGF concentrations. The present study investigates whether this pattern also occurs in neoplastic breast disease. METHODS: Serum IGF-I, IGF-II and IGFBP-3 were measured by specific radioassay in 12 women with benign breast disease, 31 patients with breast cancer and in age-matched controls. RESULTS: The mean (+/-SD) serum IGFBP-3 concentration was higher in benign breast disease (3.6+/-0.7 mg/L) than in controls (2.7+/-0.6 mg/L) or in breast cancer patients (2.7+/-0.5 mg/L) (P = 0.001). Serum IGF-I and IGF-II levels were not significantly different among the groups. However, the index of free unbound IGF measured as the molar ratio of IGF-I plus IGF-II divided by IGFBP-3 was significantly lower in benign breast disease than in the other subjects. CONCLUSIONS: Either the production or clearance of IGFBP-3 is altered in benign breast disease so that there is less free IGF available to cells. This may serve to protect against malignant transformation in patients with benign breast disorders.

Adult↗
PubMed1998

Penetrating trauma in Auckland: 12 years on.

BACKGROUND: The current spectrum of penetrating trauma presenting to Auckland Hospital is described and whether this differs from the situation in 1983 is determined. METHODS: Prospectively collected trauma registry data were used to describe the characteristics of penetrating trauma cases presenting to Auckland Hospital during the 1995 calendar year. Using data collected from a previous study in 1983, comparisons were made of the incidence, severity, and outcome of penetrating trauma cases between these two cohorts. RESULTS: In 1995, 96 patients, representing 7.3% of total trauma admissions, presented to Auckland Hospital following penetrating trauma. Of these, 32 patients were admitted by the trauma team via the resuscitation room, 13 were admitted to the intensive care unit (ICU) and four died. The median age of these patients was 30 years and median Injury Severity Score, 4. In comparison with the 1983 patients there was no demonstrable change in the numbers of patients or their length of stay. Although injury severity was similar in the 1995 cohort, fewer patients were admitted to the ICU. Mortality of the 'trauma team' group was 4/32 in 1995 compared with 7/33 in 1983. CONCLUSIONS: Despite public concerns, the frequency of penetrating trauma cases presenting to Auckland Hospital was similar in 1995 and 1983. There is a non-significant decrease in length of stay and mortality in the 1995 cohort.

Adolescent↗
PubMed1993

Severe blunt assault injuries at Auckland Hospital.

The incidence and nature of severe blunt assault injury in the Auckland region was assessed by a retrospective review over a 2-year period. Approximately 14,000 charges of assault (excluding paediatric and sexual assault) were laid during this period. A total of 1035 people were admitted to hospital. Of 331 patients admitted to one hospital, 35 patients were admitted via the resuscitation room after severe assault; of these, two died. Of these patients, 33 were male and 19 of 21 ethanol levels measured were greater than 17 mmol/l. Head and facial injuries were the most frequent.

Adolescent↗
PubMed1993

Resuscitation following injury: an end or a means?

It is known that a successful outcome after injury requires haemostasis and replacement of intra- and extracellular fluid losses. In situations of controlled haemorrhage rapid replacement of these fluid losses is likely to be associated with the least morbidity. When considering uncontrolled haemorrhage, however, there is good evidence that effective resuscitative devices and strategies have proven to be associated with a worse outcome when used initially than when their use follows surgical control of bleeding. Despite newer developments in resuscitative technique, surgeons must continue to be involved in the early management of the severely injured so that they are in the best position to employ their skills and provide surgical haemostasis when and where it is required. The 'end' therefore in resuscitation of the injured is a normovolaemic, normotensive patient who is physiologically stable and able to have definitive management of his/her anatomic injuries. The 'means' are good prehospital care, accurate initial assessment and resuscitation that employs temporary and definitive haemostasis combined with adequate volumes of appropriately chosen and delivered resuscitation fluid.

Animals↗
PubMed1990

A comparison of AIS-85 with AIS-80 for injury scaling in blunt trauma.

As the effects on injury scaling of the differences between the 1980 and 1985 revisions of the AIS are unknown in blunt trauma, we compared them in all 1270 critically injured (median ISS, 26) blunt trauma patients (75% male, 74% road crash, overall mortality 17%) admitted to the Department of Critical Care Medicine at Auckland Hospital from 1983 through 1987. In 911 patients (72%) there were no differences between AIS-80 and AIS-85 in any body region or in derived ISS. Changes in AIS grades were most common in the abdomen (205 patients), thorax (100 patients), and head (61 patients) regions. Median ISS overall for the 1270 patients was unchanged at 26. One percent of patients had changes in ISS of 16-24 points. Direct comparison of groups of patients scored with these two revisions of the AIS is inappropriate, particularly in those with abdomen region injury.

Humans↗
PubMed1990

Injury scaling at autopsy: the comparison with premortem clinical data.

The difference between injury scaling performed in the same patients on the basis of clinical information only and postmortem examination only is largely unknown. We compared scores in all 279 trauma patients who died in the Department of Critical Care Medicine at Auckland Hospital from 1982 through 1987 (93% blunt trauma, 4% penetrating trauma, 3% burns; median time until death--2 days) using both the 1980 and 1985 revisions of the Abbreviated Injury Scale (AIS-80, AIS-85) and derived Injury Severity Scores (ISS-80, ISS-85) where such scoring was based on clinical information only (CLAIS, CLISS) or postmortem findings only (PMAIS, PMISS). For the group as a whole, there was little difference in the distribution of scores between CLAIS and PMAIS or between CLISS and PMISS. However, CLISS-80 was different from PMISS-80 in 68% of individual patients. Most major differences between CLAIS and PMAIS (two AIS grades or more) occurred in the Head region, where injury scoring based on physiological features (e.g. coma) occurred without an anatomic injury of similar AIS grade, or in the Thorax region where therapy had either abolished the evidence of injury (e.g. pneumothorax) or injuries were discovered at postmortem examination which had not been appreciated clinically. Injury scaling data derived only from postmortem examination is not equivalent to that derived clinically. For maximum accuracy, postmortem data must be derived from an examination specifically guided by the needs of injury scaling and in full cognizance of injuries recognised and treated clinically.

Adult↗
PubMed1989

Computed tomography in the initial evaluation of the cervical spine.

Unstable injury of the cervical spine must be considered in all victims of blunt trauma. To evaluate the role of limited, directed computed tomography (CT) in the initial evaluation of the cervical spine, a one-year study involving 104 high-risk patients was undertaken. Sensitivity was 0.78 overall, but in the group of patients scanned after inadequate plain radiographs, CT had a sensitivity of 1.0 for unstable cervical injury. All false-negative studies involved atlantoaxial rotary subluxation. We conclude that limited, directed CT of the cervical spine is appropriate in the initial evaluation of patients at risk, particularly if plain radiographs are inadequate, but is of limited value in the evaluation of ligamentous injury of the upper cervical spine.

Adolescent↗
PubMed1989

Clinical prospective injury severity scoring: when is it accurate?

The development of Condensed Abbreviated Injury Scaling (CAIS) charts (based on AIS-85) has allowed the development of a method to perform early prospective clinical injury scoring (ISS). This information, when available within hours of admission, has allowed an awareness of the magnitude of injuries and creates an appropriate atmosphere for clinical management. In addition, ISS may be used as a rough guide to length of stay and the cost of care for the trauma patient. Three hundred thirty-seven patients entering a Level I Trauma Center were prospectively scored on a daily basis to determine the relationship between time following admission and accuracy. Overall, 18 patients (4.9%) required subsequent changes in their Injury Severity Scores after 24 hours. Patients having severe injury (ISS greater than 16) from blunt trauma had a higher likelihood of having "delayed" diagnosis that resulted in a slightly higher ISS. Overall, the accuracy of this scoring technique was 95% at 24 hours, 98% at 72 hours, and 99% at 5 days.

Adult↗
PubMed1988

Injury in Auckland, New Zealand: an unexplored epidemic.

The applicability of regionalization of injury care in New Zealand has not yet been investigated. In a first attempt to define the extent of the problem, all injured patients presenting to the resuscitation room in the emergency department of a large teaching hospital over a 1-year period were studied. Data on mechanism of injury, injury severity, resource utilization, management and outcome were recorded. A total of 602 patients was evaluated. Of these 37 per cent had Injury Severity Scores greater than or equal to 16 and 24 per cent were admitted to intensive care. Overall mortality was 10 per cent with the mean ISS for CNS related deaths being 39; for non-CNS related deaths, 46. The study confirmed that the characteristics of nonpenetrating injury in New Zealand were similar to the USA. Extrapolating from US data, one could anticipate that up to 30 per cent of deaths following injury in NZ annually may be preventable. If regionalization could reduce this rate to just 10 per cent, 360 lives could be saved annually with a contribution of $8 million to the GNP and $2.2 million to the annual government tax accounts.

Adolescent↗
PubMed1988

Routine pelvic radiography in severe blunt trauma: is it necessary?

To evaluate the hypothesis that all victims of severe blunt trauma require a pelvic radiograph, we prospectively studied all such patients admitted to the Southern New Jersey Regional Trauma Center during a seven-month period. All patients were classified as unconscious; impaired; awake, alert, and symptomatic; or alert, oriented, and asymptomatic for pelvic fracture on admission. All underwent a plain anterior-posterior radiograph of the pelvis. A total of 265 patients were studied and 26 pelvic fractures were identified. These occurred in seven of 36 unconscious patients, 11 of 96 impaired patients, and eight of 23 symptomatic patients. No fractures were identified in 110 awake, alert, oriented, and asymptomatic patients (P less than .0001). We conclude that pelvic radiographs are required in unconscious or impaired victims of severe blunt trauma and those with signs or symptoms of pelvic fractures but are not required in the awake, alert, and asymptomatic patient.

Adult↗
PubMed1988

Late patency of the carotid artery after endarterectomy. Problems of definition, follow-up methodology, and data analysis.

To determine the relative incidence of recurrent carotid stenosis (RCS) and the effect of methodology on data analysis and interpretation, late results were obtained for 232 patients (270 procedures) from 1 to 51 months (mean 22 months) after carotid endarterectomy (group A). Patency of the carotid artery was confirmed by postoperative intravenous digital subtraction angiography (DSA) for most of the series, and a subset (subgroup A1) of 113 patients (129 procedures) also received DSA studies at later intervals of 4 to 49 months (mean 26 months). There were 23 late deaths and five late strokes. Only two of the strokes were ipsilateral to previous endarterectomy, and both of these patients had normal follow-up DSA studies. Late DSA imaging revealed either no RCS or only trivial defects (20% diameter or less) in 111 arteries, moderate (36% to 60%) RCS in nine, severe (70% to 90%) RCS requiring secondary procedures in eight, and internal carotid occlusion in one. Depending on the definition of RCS (secondary operation vs greater than or equal to 30% angiographic lesions), the cohort selected for analysis (group A vs subgroup A1), and the approach to calculations (crude vs cumulative), the incidence of recurrent stenosis after carotid reconstruction in this single study could be expressed within the extraordinary wide range of 3% to 32%. Although carotid endarterectomy was associated with uniformly low risk for late stroke, these results confirm that the reported recurrence rate may be substantially influenced by the method in which data are grouped and manipulated. Consistently presented data are essential to any comparisons concerning the surgical therapy for extracranial disease.

Actuarial Analysis↗
PubMed1988

The Abbreviated Injury Scale, 1985 revision: a condensed chart for clinical use.

Refinements in injury scaling of blunt trauma and expansion to include penetrating injuries have resulted in the publication of the 1985 revision of the Abbreviated Injury Scale (AIS). To simplify use of this scale for Injury Severity Scoring in clinical practice, two 8 1/2" x 11" charts, which can be included in the patient record, have been developed from the AIS dictionary. Separate charts apply to blunt and penetrating trauma. Previous experience with a condensed AIS chart (CAIS) using the 1980 revision of the dictionary suggests that such edited revisions can result in accurate injury scaling in more than 95% of patients presenting to a Level I Trauma Center. The availability of such charts assists in calculation of the ISS soon after admission, which may prove to be a valuable teaching tool and useful in resource allocation, audit, and assessment for prospective payment.

Humans↗